Lethal mixed intoxication with propofol in a medical layman

The authors report on a drug fatality of a 21-year-old man with a propofol (2,6-di-isopropylphenol) dependency. Propofol was detected in tissues and body fluids using SPME-GC/MS methods. The postmortem concentrations of propofol were 364 ng/ml in urine, 71 ng/ml in heart blood and 79 ng/ml in femoral blood. The drug addict had only an autodidactic medical knowledge, but had inserted himself a permanent cannula for intravenous injection of propofol several times a day. The injection material was bought via online auctions from eBay. The case illustrates how job-related drug dependencies become indistinct due to the free access to information and goods via the Internet.     

Atypical "body packing syndrome"--a case report

A case of ingested cocaine is reported in which death must be classified as body packer syndrome although both the temporal relationship and the number of packets were atypical. The deceased, a consumer of hard drugs who smuggled for his own use, was found in his flat. He was resuscitated and survived for another four days in hospital. Only four intact drug packages were found in the upper gastro-intestinal tract. The concentrations of cocaine in blood and organs were relatively low but in a potentially lethal range. The case is presented, and its particularities as well as the option of induced vomiting as a way of preventing the fatal outcome are discussed.     

Three-dimensional surface topography acquisition and analysis for firearm identification

In the last decade, computer-based systems for the comparison of microscopic firearms evidence have been the subject of considerable research work because of their expected capability of supporting the firearms examiner through the automated analysis of large amounts of evidence. The Integrated Ballistics Identification System, which is based on a two-dimensional representation of the specimen surface, has been widely adopted in forensic laboratories worldwide. More recently, some attempts to develop systems based on three-dimensional (3D) representations of the specimen surface have been made, both in the literature and as industrial products, such as BulletTRAX-3D, but fundamental limitations in achieving fully automated identification remain. This work analyzes the advantages and disadvantages of a 3D-based approach by proposing an approach and a prototype system for firearms evidence comparison that is based on the acquisition and analysis of the 3D surface topography of specimens, with particular reference to cartridge cases. The concept of 3D virtual comparison microscope is introduced, whose purpose is not to provide fully automated identification, but to show how the availability of 3D shape information can provide a whole new set of verification means, some of them being described and discussed in this work, specifically, visual enhancement tools and quantitative measurement of shape properties, for supporting, not replacing, the firearm examiner in reaching the final decision.     

Bank security dye packs: synthesis, isolation, and characterization of chlorinated products of bleached 1-(methylamino)anthraquinone

Banknote evidence is often submitted after a suspect has attempted to disguise or remove red dye stain that has been released because of an anti-theft device that activates after banknotes have been unlawfully removed from bank premises. Three chlorinated compounds have been synthesized as forensic chemical standards to indicate bank security dye bleaching as a suspect's intentional method for masking a robbery involving dye pack release on banknotes. A novel, facile synthetic method to provide three chlorinated derivatives of 1-(methylamino)anthraquinone (MAAQ) is presented. The synthetic route involved Ultra Clorox bleach as the chlorine source, iron chloride as the catalyst, and MAAQ as the starting material and resulted in a three-component product mixture. Two mono-chlorinated isomers (2-chloro-1-(methylamino)anthraquinone and 4-chloro-1-(methylamino)anthraquinone) and one di-chlorinated compound (2,4-dichloro-1-(methylamino)anthraquinone) of the MAAQ parent molecule were detected by gas chromatography mass spectrometry (GC-MS), and subsequently isolated by liquid chromatography (LC) with postcolumn fraction collection. Although GC-MS is sensitive enough to detect all of the chlorinated products, it is not definitive enough to identify the structural isomers. Liquid-state nuclear magnetic resonance (NMR) spectroscopy was utilized to elucidate structurally the ortho- and para-mono-chlorinated isomers once enough material was properly isolated. A reaction mechanism involving iron is proposed to explain the presence of chlorinated MAAQ species on stolen banknotes after attempted bleaching.     

Forensic medical characteristics of Glock 19 pistol-shot wounds

An experimental study was made of gun-shot wounds inflicted by shots from a modern stub-barrelled pistol 9mm Glock 19. The study has ascertain characteristics differentiating injuries inflicted by shots from this pistol: specific recoil injury, specific topography, intensity and distribution of begrime, gunpowder and metal particles and relevant lesions. It was found that depth of penetration under the skin depends both on shooting distance and the position of the particle from the inlet.     

Prevalence of mental disorders and deliberate self-harm in Greek male prisoners

The aim of this survey was to determine the prevalence of current and lifetime mental disorder and deliberate self-harm among male prisoners in Greece. The subjects were 80 randomly selected remanded and sentenced prisoners in a Greek prison. They were assessed for mental disorder including suicidality and substance misuse using the Mini International Neuropsychiatric Interview (MINI). We also collected information regarding contact with psychiatric services, previous deliberate self-harm as well as physical health and conducted a brief assessment of their intellectual functioning. Mental disorder was diagnosed in 63 (78.7%) prisoners. The main diagnoses were: anxiety disorder, 30 (37.5%); major depression, 22 (27.5%); antisocial personality disorder, 30 (37.5%); alcohol dependence, 21 (26.3%) and opiate dependence 22 (27.5%) and schizophrenic or bipolar disorder 9 (11.2%). Deliberate self-harm prior to and during imprisonment was reported by 15% and 2.5% of prisoners, respectively, and 12 prisoners (15%) had IQ below 75. This survey identified a significant level of need for specialist mental health services in prison. Further studies are required to assess the specific needs of those patients who are too unwell to remain in prison, the need for specific treatments for substance misuse and improved assessment/treatment of common psychiatric disorders.     

The narrative structure of psychiatric reports

The present contribution illustrates the findings of a research about the narrative structure of psychiatric expertise. We have analysed a sample of nine expertises, using the methodology proposed by Roland Barthes in his book S/Z, in which he applies it to Honoré de Balzac's "Sarrasine". Barthes suggests that every narrative is characterized by the presence of five codes (hermeneutical, proairetic, semantic, symbolic and referential): we have searched for them in the expertises, but we have also observed the presence of many lapsus calami. As for our results, we have interpreted the massive presence of symbolic code in an expertise as a proof of the elaboration of the horror elicited by crime in the expert's narrative and, on the other side, the presence of referential code as the proof of the incapacity to treat such feeling and the necessity to defend himself from it. In this vision, lapsuses arise when the expert is astonished by the horror of the crime, and does not succeed in elaborating it either by using symbolic code or through his cultural resources (referential code). Finally, some reflections are made upon the difficulty for the voice of the defendant to be heard in the texts written about him.     

Psychiatric assessment after every six years of the TBS order in the Netherlands

Protecting the public from dangerous mentally ill offenders is an important issue in may countries. The UK, Scotland and Germany for example are looking for new ways to deal with this issue and some have looked at the Dutch system of first sending the offender to prison for a number of years and then for treatment to a secure clinical facility. Dutch law uses the term TBS: detention at the government's pleasure. Legal rights of the patient under the TBS-order are protected by regular evaluations to help the court determine if the patient still poses a danger to society. These evaluations take place every two years, at the end of each extension period. Every six years an extra assessment by independent experts is obligatory. In this same period other types of assessment occur too, such as for transferral to a long-stay unit. A complicated succession of experts may visit the patient, asking the same questions and using the same files, distracting his or her attention and motivation from the treatment process. This system is threatened by the qualitative and quantitative scarcity of properly qualified experts. Measures have been taken to counteract these difficulties, but will they suffice?